Blood problems after Afoxolaner + Moxidectin + Pyrantel (NexGard PLUS) in dogs

59 reports to the FDA describe blood problems in dogs given Afoxolaner + Moxidectin + Pyrantel. That is 0.6% of all reports for this medicine, compared with 1.8% across reports for all dog medicines, so it is reported less often than average with this medicine.

59Reports
63%Marked serious
14%Recovered
20%Died or euthanised
3 daysTypical onset
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How soon it started

Same day
10 18%
1–2 days
15 27%
3–7 days
8 15%
1–4 weeks
8 15%
Over a month
14 25%

How the animals did

Recovered
8 14%
Still unwell when reported
20 34%
Died
6 10%
Euthanised
6 10%
Not known
19 32%

Problems reported at the same time

Age of the animals

Under 1 year
21
1–3 years
14
4–7 years
4
8–11 years
14
12+ years
5

About this medicine

Afoxolaner kills fleas and ticks; given as a monthly chewable. Moxidectin prevents heartworm disease (monthly topical, or a 6- or 12-month injection for dogs). Pyrantel treats roundworms and hookworms.

Products with this combination include NexGard PLUS. The FDA hides brand names in its public data, so these reports cover every product with the same active ingredients.

In 2018 the FDA alerted owners and vets that isoxazoline products have been associated with neurologic reactions such as muscle tremors, wobbliness (ataxia) and seizures, including in animals with no history of them.

Questions owners ask

Can Afoxolaner + Moxidectin + Pyrantel cause blood problems in dogs?
59 reports link the two, but a report alone does not prove the medicine was the cause: other illnesses, other medicines or coincidence can be involved. Your vet can judge it for your animal.
How soon after a dose was it reported?
In half of the reports with dates, it started within 3 days of the first dose.
What should I do?
Don't give another dose until you've spoken to your vet, and keep the packaging so you can tell them the product and dose. Your vet can also report it to the FDA (or you can, through the manufacturer or FDA form 1932a).

Blood problems with similar medicines

All reported side effects of Afoxolaner + Moxidectin + Pyrantel in dogs · Medicines most reported with blood problems